August 7, 2019

A theoretical framework and competency-based approach to improving handoffs

BACKGROUND Once characterised by remarkable continuity of care by a familiar doctor, patient care today is delivered by multiple physicians with varying degrees of knowledge of the patient. Yet, few trainees learn the potential risks of these transitions and the strategies to improve patient care during handoffs. Little is known […]
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BACKGROUND Once characterised by remarkable continuity of care by a familiar doctor, patient care today is delivered by multiple physicians with varying degrees of knowledge of the patient. Yet, few trainees learn the potential risks of these transitions and the strategies to improve patient care during handoffs. Little is known regarding the mechanisms by which handoffs affect patient care. RESULTS Building on theoretical constructs from the social sciences and illustrated with a case study of the implementation of a night float service for the inpatient general medicine services at the University of Chicago, a conceptual framework is proposed to describe how handoffs affect both patients and physicians. CONCLUSION Using this conceptual framework, recommendations are made for formal education based on the core competencies of communication and professionalism. Opportunities to educate trainees in acquiring these skills are described in the context of handoffs of patient care.
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http://qualitysafety.bmj.com/content/17/1/11.full?sid=eb79ca0a-ea29-4a55-a7b9-fe67c68b1be5

August 7, 2019

Improving patient safety culture

PURPOSE Improving hospital patient safety means an open and stimulating culture is needed. This article aims to describe a patient safety culture improvement approach in five Belgian hospitals. DESIGN/METHODOLOGY/APPROACH Patient safety culture was measured using a validated Belgian adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Studies […]
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PURPOSE Improving hospital patient safety means an open and stimulating culture is needed. This article aims to describe a patient safety culture improvement approach in five Belgian hospitals. DESIGN/METHODOLOGY/APPROACH Patient safety culture was measured using a validated Belgian adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Studies before (autumn 2005) and after (spring 2007) the improvement approach was implemented were completed. Using HSOPSC, safety culture was measured using 12 dimensions. Results are presented as evolving dimension scores. FINDINGS Overall, 3,940 and 3,626 individuals responded respectively to the first and second surveys (overall response rate was 77 and 68 percent respectively). After an 18 to 26 month period, significant improvement was observed for the "hospital management support for patient safety" dimension--all main effects were found to be significant. Regression analysis suggests there is a significant difference between professional subgroups. In one hospital the "supervisor expectations and actions promoting safety" improved. The dimension "teamwork within hospital units" received the highest scores in both surveys. There was no improvement and sometimes declining scores in the lowest scoring dimensions: "hospital transfers and transitions", "non-punitive response to error", and "staffing". RESEARCH LIMITATIONS/IMPLICATIONS The five participating hospitals were not randomly selected and therefore no representative conclusions can be made for the Belgian hospital sector as a whole. Only a quantitative approach to measuring safety culture was used. Qualitative approaches, focussing on specific safety cultures in specific parts of the participating hospitals, were not used. PRACTICAL IMPLICATIONS Although much needs to be done on the road towards better hospital patient safety, the study presents lessons from various perspectives. It illustrates that hospital staff are highly motivated to participate in measuring patient safety culture. Safety domains that urgently need improvement in these hospitals are identified: hospital transfers and transitions; non-punitive response to error; and staffing. It confirms that realising progress in patient safety culture, demonstrating at the same time that it is possible to improve management support, is complex. ORIGINALITY/VALUE Safety is an important service quality aspect. By measuring safety culture in hospitals, with
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http://www.emeraldinsight.com/journals.htm?articleid=1865014

August 7, 2019

CAPS Brochure: The Emotional Side of Healthcare: Six Tips for Talking to Your Doctor

A tri-fold brochure presenting six strategies for coping with conversations that often feel stressful for patients and families. This can also serve as a reminder or educational tool for healthcare team members to raise their sensitivity to the emotional realities patients bring with them as they talk to their doctor […]
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A tri-fold brochure presenting six strategies for coping with conversations that often feel stressful for patients and families. This can also serve as a reminder or educational tool for healthcare team members to raise their sensitivity to the emotional realities patients bring with them as they talk to their doctor or nurse.
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http://www.patientsafety.org/file_depot/0-10000000/20000-30000/24986/folder/85204/Emotional_brochure.pdf

August 7, 2019

Care transitions for hospitalized patients

Ensuring safe care transitions is a core part of hospital medicine. These transitions include inpatient-outpatient transitions and in-hospital transitions. To ensure safe care during these transitions, clinicians should be aware of the types of transitions and the way in which these transitions can impede safe patient care. With this knowledge, […]
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Ensuring safe care transitions is a core part of hospital medicine. These transitions include inpatient-outpatient transitions and in-hospital transitions. To ensure safe care during these transitions, clinicians should be aware of the types of transitions and the way in which these transitions can impede safe patient care. With this knowledge, strategies to ensure patient safety during care transitions can be adopted and training directed at teaching physicians safe hands-off practices could be developed and supported.
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http://www.sciencedirect.com/science/article/pii/S002571250700171X

August 7, 2019

Improving transitions of care at hospital discharge–implications for pediatric hospitalists and primary care providers

Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of […]
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Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high.
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http://scienceindex.com/stories/1058641/Improving_Transitions_of_Care_at_Hospital_DischargeImplications_for_Pediatric_Hospitalists_and_Primary_Care_Providers.html

August 7, 2019

Assessing the quality of transitional care: further applications of the care transitions measure

BACKGROUND The Institute of Medicine has identified care transitions as a priority area for performance measurement. OBJECTIVES To examine the performance of the Care Transitions Measure (CTM) in more diverse populations and to introduce a 3-item CTM. RESEARCH DESIGN: Cross-sectional study with purposive sampling of traditionally underserved populations. Confirmatory factor […]
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BACKGROUND The Institute of Medicine has identified care transitions as a priority area for performance measurement. OBJECTIVES To examine the performance of the Care Transitions Measure (CTM) in more diverse populations and to introduce a 3-item CTM. RESEARCH DESIGN: Cross-sectional study with purposive sampling of traditionally underserved populations. Confirmatory factor analyses, internal consistency reliability analyses, and differential item function tests were performed to explore the stability and performance of the 15-item CTM. Regression assessed the ability of the 3-item CTM to predict the 15-item CTM total score. Analysis of variance tests were conducted to explore CTM performance in different populations with respect to health and demographics. SUBJECTS A total of 225 patients age 18-90 who were hospitalized in the past 12 months and were African American, Hispanic American, or rural-dwelling. MEASURES CTM-15, CTM-3, age, gender, education, and health status. RESULTS Mplus confirmatory factor analysis supported the CTM-15 factor structure in more diverse population (Comparative Fit Index [CFI] = 0.954). The 3-item CTM explained 88% of the variance in the 15-item CTM score. Differential item function analysis did not reveal any differential item difficulty by age, gender, education, self-rated health, or group (African American, Hispanic American, and rural-dwelling). CONCLUSIONS Following endorsement by National Quality Forum, findings support use of the CTM in national public reporting efforts. The 3-item CTM closely approximates the 15-item instrument and may be attractive to purchasers and health care organizations that want to assess quality in this area while minimizing cost and response burden.
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http://journals.lww.com/lww-medicalcare/Abstract/2008/03000/Assessing_the_Quality_of_Transitional_Care_.12.aspx

August 7, 2019

Effectiveness of a medication discharge plan for transitions of care from hospital to outpatient settings

PURPOSE The effect of a medication discharge plan (MDP) on the rate of medication discrepancies between hospital and outpatient settings was evaluated. METHODS In a pragmatic, open, randomized, controlled trial, MDPs were completed for all patients before discharge from the hospital. Patients were then assigned to either an MDP group, […]
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PURPOSE The effect of a medication discharge plan (MDP) on the rate of medication discrepancies between hospital and outpatient settings was evaluated. METHODS In a pragmatic, open, randomized, controlled trial, MDPs were completed for all patients before discharge from the hospital. Patients were then assigned to either an MDP group, for whom MDPs were sent to community pharmacies and treating physicians, or a usual care group, for whom an MDP was not sent. Discrepancies between MDPs and community pharmacy dispensing records and medication use reported by patients during a telephone interview were documented. The percentage of patients with discrepancies and the mean percentage of medications with discrepancies were compared between the two groups. The clinical severity of discrepancies was blindly evaluated. RESULTS A total of 83 patients agreed to participate in the study. The percentage of patients with at least one discrepancy was high and similar in both groups when MDPs were compared with pharmacy dispensing records and patient self-reports. Comparison of MDPs to pharmacy dispensing records revealed discrepancies for 13-15% of medications; more than a third were clinically significant. Comparison of MDPs to patient self-reports revealed discrepancies for 10-12% of medications; 48% were clinically significant. No significant differences were observed between the two groups. CONCLUSION The rate of medication discrepancies was not decreased in patients whose MDP was provided to their community pharmacy and physician at the time of hospital discharge compared with the rate in patients who received usual care.
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http://www.ajhp.org/content/65/15/1451.abstract?sid=b61120f6-431f-4a99-8627-8acfb950c777

August 7, 2019

Addressing the business of discharge: Building a case for an electronic discharge summary

Hospitalists are increasingly involved in implementing quality improvement initiatives around patient safety, clinical informatics, and transitions of care, but may lack expertise in promoting these important interventions. Developing a sound business case is essential to garnering support and resources for any quality improvement initiative. We present a framework for developing […]
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Hospitalists are increasingly involved in implementing quality improvement initiatives around patient safety, clinical informatics, and transitions of care, but may lack expertise in promoting these important interventions. Developing a sound business case is essential to garnering support and resources for any quality improvement initiative. We present a framework for developing a business case using a structured approach to exploring qualitative and quantitative costs and benefits and describe its application in the experience of developing an electronic discharge summary at the University of California San Francisco (UCSF). At our institution, we found that the primary financial benefits are the cost reductions in eliminating transcription needs and decreasing billing delays, as well as reducing the cost of tracking completion of and dissemination of discharge summaries. Costs incurred from a new information technology (IT) infrastructure, programmer time, maintenance and training must also be accounted for. While benefits may be apparent to front line providers (improved communication, efficiency of data transfer, and increased referring physician satisfaction), implementing and sustaining such an innovation depends on articulating a sound business case with a detailed cost-benefit analysis to institutional decision making.
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http://hospitalmedicine.ucsf.edu/downloads/addressing_the_business_case_of_e-discharge_summary.pdf

August 7, 2019

Consumers Advancing Patient Safety: Transitions Toolkit

Hospital discharge is a time during which patients and families are at their most vulnerable. There is so much information they need to know, just when they may be least able to absorb, remember and act on it. It is vital for members of the healthcare team to help patients […]
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Hospital discharge is a time during which patients and families are at their most vulnerable. There is so much information they need to know, just when they may be least able to absorb, remember and act on it. It is vital for members of the healthcare team to help patients leave the hospital with confidence, giving them the tools and information they need to make a smooth transition to their next destination. This toolkit, Taking Charge of your Healthcare: Your Path to Being an Empowered Patient, provides you with these tools
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http://www.patientsafety.org/page/transtoolkit/;jsessionid=3p5dqlgcj2sgp

August 7, 2019

Enabling joint commission medication reconciliation objectives with the HL7 / ASTM Continuity of Care Document standard

We sought to determine how well the HL7/ASTM Continuity of Care Document (CCD) standard supports the requirements underlying the Joint Commission medication reconciliation recommendations. In particular, the Joint Commission emphasizes that transition points in the continuum of care are vulnerable to communication breakdowns, and that these breakdowns are a common […]
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We sought to determine how well the HL7/ASTM Continuity of Care Document (CCD) standard supports the requirements underlying the Joint Commission medication reconciliation recommendations. In particular, the Joint Commission emphasizes that transition points in the continuum of care are vulnerable to communication breakdowns, and that these breakdowns are a common source of medication errors. These transition points are the focus of communication standards, suggesting that CCD can support and enable medication related patient safety initiatives. Data elements needed to support the Joint Commission recommendations were identified and mapped to CCD, and a detailed clinical scenario was constructed. The mapping identified minor gaps, and identified fields present in CCD not specifically identified by Joint Commission, but useful nonetheless when managing medications across transitions of care, suggesting that a closer collaboration between the Joint Commission and standards organizations will be mutually beneficial. The nationally recognized CCD specification provides a standards-based solution for enabling Joint Commission medication reconciliation objectives.
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http://proceedings.amia.org/1amojs/1?highlightText=Enabling%20joint%20commission%20medication%20reconciliation%20objectives%20with%20the%20HL7%20%2F%20ASTM%20Continuity%20of%20Care%20Document%20standard&